Loading...
HomeMy WebLinkAboutGRECIAN HILLS BLK 1 LT 2Grecian Hills Lot 2 Block 1 #017-073-61 'VOM 1 1A FEB 2 g 2014 Municipality of Anchorage Community Development Department Page 1 of 2 4700 Elmore St. • P.O. On -Site Water and Wastewater Program Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141018 PID Number: 017-074-30 ❑ New 0 Upgrade Name: Jeanette Delaney ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other Address 13250 Messinia Street Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft, Gravel depth beneath pipe Ft. Subdivision Grecian Hills Block Lot 1 2 Fill added above original grade Ft, Gravel length Ft. Township Range Section Gravel widthBeds: Ft. Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Fe Number of trenches Dist. between trenches Ft. Well N/A N/A N/A 127.9 103.5 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 2000Gal. Surface Water N/A N/A N/A 100+ Material Number of compartments Lot Line N/A N/A N/A 21.0 NA Steel 1 Foundation N/A N/A N/A 10.2 LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at In. Pump make and model Electrical Inspections performed by Installer Beeks Contracting PIPE MATERIAL Housetotank 3034 Tank to drainfield Drainfield CO/MT 3034 Inspector Steven R. Pannone BENCHMARK (Assumed elevation) 100ft Insp. 2/7/2014 dates: 1 30 2"� 4" Location and description Garage finish floor COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval:Date y(rG F, ✓ 7 :TR tEver I$ f�annvtae` l� or1 #s Approved pp Date w y� i......e..r...., o.......e A 7 B C1 16.7 29.9 T1 13.0 35.7 T2 14.5 39.5 ALARM 18.2 42.7 WELL (E) 5 WELL (E) I 'Z \ dG \ W /M M SEPTIC AREA (E) NEW 20009 HOLDING TANK I COLLAPSED HOLDING TANK ABANDONED PER CODE SEPTIC AREA (E) v ALARM2oTa ~a�Z o00 ww C) g F Q�Iw`3L (E) O o w OfJ J J W N >3ofi II O O O In \ 002 O O K Q 99EHOLDING ��— SEPTIC AREA (E) � � ILL 93.0 NN M �MEW TA \� TANK NOTES:ENG SVC, ',���� �1 \ Date PAMONE LLC r l RECORD DRAWING P.O. BOX 110,012217 ANCHORAGE, AK 99510 i ��OF !'�.'gSll1 2/19/14 PHONE (907) 272-8218 FAX (907) 272-8211 /�g�P �y�� Scale �..... .. .. .... P.I.D. NO GRECIAN HILLS, BLOCK 1, LOT 2......... ' 1017-074-30 JEANETTE DELANEY Steven R. 'annone PERMIT N0. 13250 MESSINIA STREET �`#��is• GE 8149 �/ OSP141018 PLAN ANCHORAGE, AK 99516 (kl:�Di�ssov�G 5h2eOP 2 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141018 Tax Code Number: 01707430000 Work Type: SepticTank Upgrade Permit Effective Dates: February 07, 2014 to February 07, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: GRECIAN HILLS Site Legal Address: GRECIAN HILLS BLK 1 LT 2 G:2940 Owner/Address: DELANEY JEANETTE N 13250 MESSINIA ST ANCHORAGE AK 995163809 Site Mailing Address: 13250 MESSINIA ST, Anchorage This permit is for the construction of: N Disposal Field N Septic Tank Y Holding Tank N Privy Lot Size in Sq Ft: 16937 Total Bedrooms: 3 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The shape and location of the house shall be verified and shown correctly on the engineer's as -built drawing. Received Issued By: Bv: Date:..) X40 f' Date: c� 1 RUSH! MUNICIPALITY OF ANCHORAGE `�: ► Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICAT MITTA %; L Parcel I.D. 017-074-30 Property owner(s) Jeanette Delaney Day phone Mailing address 13250 Messinia St., Anchorage, AK 99516 Site address 13250 Messinia Street Legal description (Sub'd., Block & Lot) Grecian Hills, Block 1, Lot 2 Legal description (Township, Range & Section) Lot Size 16,937 Sq. Ft. Number of Bedrooms 3 FEB 6 2014 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) ElHolding Tank Q Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: .2/5".41 Date of Payment: '21(011 t/ Receipt Number: 619 ��9C Permit No. 615 ply/U l p Permit App_:- ? :L:c- Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenzak.com February 5, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Grecian Hills, Block 1, Lot 2 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to replace the holding tank be issued for this property. The existing holding tank has collapsed putting the homeowner out of service and exposing raw sewage to the environment. The proposed tank will serve an existing three (3) bedroom house. The existing holding tank will be abandoned per code. This lot is served by a class `C well that is located 105.5 feet from the existing holding tank, and 120 feet from the proposed holding tank. The surrounding lots are served by private wells that are located over 100' from this system. 1. Soils. The soils log on file with the On -Site department show that a previous drain field failed on the lot and that soils are silt and clay with a percolation rate of 120 minutes per inch. .:14 2. Surface Water: There is no surface water within 100 feet of the proposed saNEieta and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The topography slopes from northeast so southwest at approximately 5% in the area of the proposed holding tank replacement. There are no steep slopes in the area. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 /A'� \ � SEPTIC AREA (E) 4 *\% /g WELL (E) 1 o 5 WELL (E) SEPTIC AREA (E) /M%M M M M 20009 HOLDING TANK (P) \,y �_ W Wj COLLAPSED HOLDING TANK (E) \ `1 ABANDON PER CODE 2� z z H E-M M 3 w wV t1' DRIVEWAY 2j w 4j�° �° N o \2i 3I / a ao \ f/n/ z_ / D w 3BR HOUSE w Jo N O O N 0 —I (E) 120.0 zc>= 7i �a� No LOT 2 WELL (E) O o � ys � II I a ¢ > K J N >3 W / :k O _--� SEPTIC AREA O NOTES: PANNONE ENG SVC LLC—S OF gGq�\l� Date EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 995102/5/14 PHONE (907) 272-8218 FAX (907) 272-8211/raj�P Scale 1.._50' ... . . . .. ..... P.I.D. NO GRECIAN HILLS, BLOCK 1, LOT 2 - -074-30 JEANETTE DELANEY , St even 'R. 'P annome'� PERMIT N0. 13250 MESSINIA STREET ��+Pcif• GE 8149 . C��� osPxxxxxx PLAN ANCHORAGE, AK 99516 1��\�"Sheet�' 1 of 1 E MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION @� ENVIRONMENTAL ENGINEERING DIVISION \\1�1 825 L Street - Anchorage, Alaska y8bU'l I elepnone zn4.4/ZU �ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHONE �i 1g , Ti b- � .-- 164-1 1:J NEW UPGRADE MAILING ADDRESS 13693 SvN.ser U460 #q/JC/4Qf?A&0 Aer I 9 LEGAL DESCRIPTION Gc3-r p- j8LK I GIVE A ,'LL 'Tl A! 3vJ sec- 2s' LOCATION [ 5 S 1 5 NO. OF BEDROOMS 3 Uy Well DISTANCE TO: Absorption area Dwelling PERMIT NO. P Z aQ wF Manufacturer t5z- Material No. of compartments rn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ��z DISTANCE TO: Well l ICi�.S Dwelling t �i PERMI O. 0360 024 Manufacturer r Material5rE Liquid cagaFi in gallons O = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. LU LL z w No. of lines Length of each line Total length of lines Trench width inches Distance between lines HZ —¢ ¢ F- O Top of the to finish grade Material beneath the inches Total effective absorption area W Length Width Depth PERMIT NO. 0 QF CL Type of crib Crib diameter Crib depth Total effective absorption area w rn DISTANCE TO: Well Building foundation Nearest lot line J Class "C' 77 - Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER L PIPE MATERIALS 1 p/ ¢') / ✓, &- PV '/ •L'l,k-ice.. 'a✓iLL.'� N SOIL TEST RATING INSTALLERAA � /� (�''++ r � /V G T Z} 'O / ' REMARKS 1NSu[ .UE v 1 , k Co�+?�I►�-t" ©,t� rites XSY! 3r0 rt) CATES3 .S '10TA& n l, /APPROVED DATE LEGAL t4_) C., 9/z<,1eq L 2 13 1 GpEc; AU 14 j Lz3 r,2n9 34j sae_� 72-013 (Rev. 3/78) Department' E Health and Environmenta '?rotection J 825 Street, Anchorage, AK. .... 9501 264-4720 # # HANDWRITTEN PERMIT # # Permit # �% 3 (00HANDWRITTEN SEWER PERMIT O Applicant: / IE L Tl/T Mailing Address 1,3613 Uec1da Location: Got �(_32 Cr(?'rCwy Ff/cc S �;_h� Phone Number: Legal Description: soc aSS , i/r„l Lot Size: Type of Soil Absorption Syst m Is: Trench: Drainfield: --.Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _� Soil Rating(sq.ft/br) I DEPTH The Required Size of the Soil Absorption System Is: LENGTH GRAVEL DEPTH WIDTH — The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED (HOLDING) TANK SIZE 66 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer lire is. 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if, the residence is remodeled to include more that 3 bedrooms. Issued by: Applicant Date: 7 7— SWP/024 (1/81) 4, *� •�c•..c `c5 l'•„-,.fin.,,,,;f.',.. -Xv, i,-�rl ,- �,,� ul[•r13 L1nn�nvnn,,r. WHEW nur,v!r HEALTH DEPART'?ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE N M 'Performed Per, Date Verformed Legal Description: Lot Block 1 Subdivision - This Form Reports : So1 s -LOP, -= 6 percolation Test \' Depth Feet Soil Characteristics I r��,t•1 � i s , . ��. Was Ground Water Encountered? �/_� apo If Yes, At What Depth - Location Sketch Reading Date Gross Time Net Time Depth To H2O Net Drop Aw- Aj erco a -ion Rate minute Proposed Instal.lati'on: Seepage Pit Depth Of Inlet--��- Dep COMMENTS: 1%'Y/G' V in,' VMV-.§ Test Performed By._,�%��/L� Data Certified By: . Drain Field om Of Pit Or Trench i JAMES B. ROBERTS, PE, RLS ENGINEER 6 SURVEYOR CA/'(40!� PEIri% May 25, 1984 (S073349-2526 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' Mun i c i pial i ty of Hnchor•aGe A[I i z1: 19RA Division of Environmental Health Dept. of Health and Environmental Protection RECEIVED Sthl & L Street Anchorage, F="K 99501 Reference. Lot i Block f Grecian Hill= Subdivision Gentlemen; Pursuant to ,Your, request, T hereby c=ertify that from the cin-e•i to observation of the soils on the above referenced property, 1 do not believe that a waste Uda.ter absorption system meeting current Municipal requirements is feasible, `(ours very truly, (9 1207 East 74 th Avenue Anchorage, Alaska 99502 HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ��ADDRESS?'- PHONE��� LOCATION �<T ��� ���� � EGAL DESCRIPTION 'g ll SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY __2' GALLONS SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER,OF JERIAL SC C COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH. NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH /V LENGTHS DEPTH LINING MATERIAL ` �' C f DISTANCE FROM WELL / BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL_ NUMBER OF LINES ABSORPTI AREA— TOTAL LENGTH FOUNDATION , NEAREST LOT LINE , OF LINES I TANCE BETWEEN LINES TRENCH WIDTH AL EFFECTIVE SQ. FT. GTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE WELL: `` G''3efj J JB% DISTANCE FROM i WATER TYPE i DEPTH (le - B_UUIIVDING FOUNDATION.I�SAMPLENEAREST 1 NEAREST SEPTIC SEEPA ! �, OTHER - LOT LINE SEWER LINE Oir TANK, SYSCESSPOOL SOURCES_ DISTANCES UTAVKAM Ur Jl Jiun DATE v `�til� ©` G APPROVED � HEALLTHTH AUTHORITY GAAB-HD-2 ■-KL1 l'z l Li �I� �nV��Vj`j hllFJli `„JxL" U V11 t,aac Ivu. V J HEALTH DEPARTMENT "'qtr 327 Eagle St. Anchorage, Alaska 99501 279-2511, l✓ 1 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ,Ct MAILING ADDRESS 7 PHONE NO. [ RESIDENCE ADDRESS 7 LGy �" LOCATION OF INSTALLATION LEGAL DESCRIPTIO APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY �`�� ` `^ � '� FINANCED THROUGH A TO BE INSTALLED BY PERCOLATION TEST RESULTS IV ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT ' THIS IS TO SERVE AS h�^'PERMIT TO INSTALL A�'�� AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE %S'0 TYPE 1�2 SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: L i TYPE HEALTH AUTHORITY OR LICENSED DESIGNER (/Certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE � APPLICANTS SIGNATU R September 20, 1973 Frick L. Pettit S.R.A. Box 330-E Anchorage, Alaska 59507 Water sampling located on Lot Grecian Hills Dear r. Pettit. of rami -public t�rell 2, Block 1, Subdivision Kyle J. f.—Oarry, regional Environriental Engineer, has recommended your water system be accepted as a semi-public water system. (Our letter dated September 14, 1973 with a carbon copy to you.) We are adding your name to our water bottle will be forwarded a water sample and return it to insure the safety of the water Sincerely, C.S. McKecknie, Environmental Control Officer CSI-1/ko crater 1)ottIe nailing lista, A to you each month for you to take the Mate Lab for analys , to supply system. W DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE September 14, 1973. Mr. Rolf Strickland Dept. of Environmental Quality Greater Anchorage Area Borough 3330 C Street WILLIAMA EGAN, GOVERNOR 1338DENALISTREET MACKAY BUI L DING -ROOM 850 ANCHORAGE99501 Azole i? 1) SEP -1 :. t p7 AI ITER gyCHq P# 6p Anchorage, Alaska 99503 fy SUBJECT: Semi-public Well, Rick Pettit, Lot 2.Blk 1 Grecian -Subdivision Dear Mr. Strickland: I am writing to clarify our position on the semi- public well located on Lot 2, Blk 1, Grecian Subdivision. This property is owned by Mr. Rick Pettit and has to our information served as a semi-public well in the past. The septic tank is 80 Ft. from the well which meets our old semi-public requirements but some portions of the seepage area are only 100 Ft. from the well. It is felt by this office that because of the depth of the well and the material through which it was drilled that there will be little chance of contamination, even though the distance does not quite meet the old semi-public distance from well to seepage pit. Also as Mr. Pettit has been supply- ing the water to others there might be some legal problems attached to trying to cut the supply off from the people he has been supplying. We would recommend that the system be accepted as a semi-public system under the old classification and that we would waive the requirement at this -time for it having to meet the new public classification. This re- commendation is based on the requirement that a maximum of 3 connections will be made to the system and that the system will be sampled bacteriologically at the fre- quencies required by your department. In summary we would recommend the acceptance of this system as a semi-public system if the stipulations referred to above are followed. If you have any question regarding any of the above please do not hesitate to contact me. You struy,�� =,4 Kyle J. Cherry, P.E. cc: Rick Pettit Regional Environmental Engineer A MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 � Cr ` r a$44u IUN 20 2000 �411"NiUeA lly OF AN_HUKAGii vf�...,..�rNITAL SEMI('" CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING qq Parcel I.D. # 01 7 - 0 z 7 -,5'1 HAA # /� 666�2� / 1. 2. 3. a GENERAL INFORMATION Complete legal description /Of Z 91oci-, o<�eCG^ ff`/'J '�D Location (site address or directions) Property owner Ce f'y % / l o "0 f n a Day phone 3 vs - 1-71 _� Mailing address 69oi Se{uo;� C"c7t ft c o cqP /ice 99s� Lending agency Day phone Mailing address Agent Cto✓I- Day phone S63 —Sz�3 Address 3 ism "c " c A 0 �7e /-f< 99503 l Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 3 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 [Rev 1/91) Fron: MOA .21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm rlo "oe Tech, ;eat Se.- P. Phone 3 vS - Address ♦S= o Ectio SA jr ctio �cE A 99S Engineer's signature Date 6. DHHS SIGNATURE !-'- Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Date ('-_�)_2-ccz:, A�iS y4d r. f+ 1 yi i,.'kr of"+�,ltl (�s+�'i Il A."!l411V -Sri.. t1� :e, !"1� ml_.r _ L. l 1_ �F4',. a. R. iix 4. ., +dre y �$ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72L25 (Rev. 1/911 3ecz MCA 421 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LaP2 6lockl Grecran *10 S/D Parcell.D.: or7 -673-6/ A. WELL DATA Well type Ciao "c " If A, B, or C, attach ADEC letter. ADEC water system number 298229 T Log present (Y/N) N Date completed 1970 per earlier (196v) F-4,9 Total depth 19'7' Cased to > N6' Casing height (above ground) 1'2 Sanitary seal (Y/N) Wires properly protected (YIN) Y FROM WELL LOG AT INSPECTION by Arrow Pump a- used/ .Cr_ Date of test 6 /9 / a6 Static water level l 2 Well production g:p.m. 6•s g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate 2 2 2 My /-Q Other bacteria None egre —A!q Date of sample: 6,113100 Collected by: Fla Llf e Te tin, ca ( Se��tr P� B. SEPTIC OLDING TANK ATA Date installed S/ z9 /6H Tank size 2000 Number of Compartments I Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression (Y/N) n/ High water alarm (Y/N) Y Date of Pumping 6 //2- /GD Pumper A-Aotiarc.gp C_c<rpoo/ C. ABSORPTION FIELD DATA M.,4. ( Mot,(' % _-n k) Date installed Length Width Effective absorption area Date of adequacy test Soil rating (g.p.d./W or ft2/bdrm) Gravel thickness below pipe System type Total depth Monitoring Tube present (Y/N) Depression over field (Y/N) Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): - Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION N• A Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septi holding tank n lot IOS On adjacent lots "Pump off" level at* Absorption field on lot N • A. On adjacent lots > r so' Public sewer main Sewer /septic service line Public sewer manhole/cleanout N• A. Lift station N • A, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 30' Property line Absorption fie Water main/service line I so' Surface water/drainage > ( r- ;' Wells on adjacent lots > 10co' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: k) Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION Building foundation Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots I certify that I have determined thru field inspections and review of Municipal records that; the abgve;"systems are In conformance with MOA HAA guidelines in effect on this date. • Signature .i/r-9-�ce�t ��„� _ _ L f,vanaaq.a„avcuo nous en r`.4. Engineer's Name TAeoer- r /= / rvo �c ? awe J_L 91, x4 un6 aeba®ae 6a744o 000a`o- Date June 19, loop cl;-3;Es HAA Fee $ 300 Date of Payment ly I U Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 06-I9-00 12:01 FROM -CTE ENVIRONVENTAL CT&F Environmental Services Inc. CUE; Rets 1GO292700I Client Name Flattop Technical Stv. Project Name/tt LOT 2 Blk I Grecian Hills Client Sample 1D Lot 2 Blk I Grecian Hills Matrix Drinking Water Ordered By seesaw al `il a 3 3 MID .2 5615301 T-280 P.02/03 F-347 Client PON Pre -Paid Colis/NO3 Printed Date/Time 06!192000 8:20 Collected Date/time 06/132000 15:00 Received Date rime 06/132000 15:300Q Technical Director Stephen C. Ed!E��7�IWw` Released B Sample Remarks: AL towable Prep Analysis Result¢ POL Units method Limits pole Data tnir Paramerer - Maters Deparrgent 2.22 0.500 MeA EPA 300.0 10 glen 06/13/00 SCL Ni Trate-N Illeronlolou Laboratory 0 col/10DmL SMIS 92220 06/13/00 KAP Total Coliform MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lude lot, block, subdivision, section, township, range) def Ljc.acK Location (address or directions) /32- 4;0 jWes"si:v/} (b) Applicants Name $OZ1_--1wAQ Yk. Telephone - H=43V5r�56iyBusines,a/3/_5-J Applicants Address GUE (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other F::1 (explain); (d) Lending Institution A,�....�j�/y/s7"F!Z C.U. Telephon(�'))(1/1 Wee Address fLL-�5� LA5KII (e) Real Estate Co. & Agent _ Address Telephone (f) Mail the HAA to the following address: / 9 A c�9ljg51e ,�,.L i Z o« r nr-1 e w, 2. Type of Residence Single -Family �-----4 Multi -Family Other (describe) Number of Bedrooms 3 3. Water Supply i Individual Well R_71 Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite EF� Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (Page 1 of 21 ley, Ar.. ... 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm' C S I ,y C Telephone r , ( -- �61>CG Addressj 1Ae'JL1+_2X A& P 4E Date (ENGINEER SEAL) 6A VVV i �o�jsa?ao shoe oB.eyee.�e d� Larsfy C. Reid, Jr. ;F` (;/..'. ���TB,B No. 2251-C 6. DHEP Approval Approved for 111rEL�- Nbedrooms By Da'fe"// Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description:/ �� Aetr1 C9r6rinVI Ni 1)5 -%4. A _ WELL DATA Well Classification -S A, B, or C, D.E.C. Approve N) Well Log Present (YQVJ Date Completed 1r; "7C`) Yield���R;N�z,f; Total Depth /94 Cased to 11. 1k) kA),-, : ; : Depth of Grouting !J A) h k a Static Water Level PumpSet AJ Casing Height Above Ground 2 -'Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit Y ) Separation Distances from Well: To Septic/Holding Tank on Lot 1 (d 5'; gression Around Wellhead (Yom 'o16 � On Adjoining To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole To Neare Water Sample Collected By lam) Water Sample Test Results s Ll- �c:r' On Adjoining Lots To Nearest Public Seca Sewer ServieV Line on Lot ate 9h/6'4- lL rv� �v B. SEPTIC/HOLDING TAA DATA Date Installed Q ,Z Size ) 0 No, of I Compartments StandpipesMN) Air -tight Caps Y'N) Foundation Cleanout ) Depression over Tank (YT Date Last Pumped- Pumping/Mainterance Contract on FileY/N) ; for-�" O es O P .Aj�_c)T Holding Tank High -Water Alarm (Y/N) Temporat�\ Holding Tank Permit (Y�LV�� Separation Distances from Septic/Holding Tank: To Water -Supply Well jQr, y To Building Foundation_ -3i To Property Line 66A To Disposal Field "ifra To Water Main/Service Line A� pl To Stream, Pond, Lake, or Major Drainage (Page 1 of 21 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed /)1 Length of Field ;.)%ya Width of Field I J� /ij Depth of Field JZ/ Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/W) AVYI Depression over Field (YM) ,/u/,KV Date of Last Adequacy Test ,-) II Results of Last Adequacy Test A./44 - Separation Distance from Absorption Field: To Water -Supply Well � /pa, To Property Line A To Building Foundation 4?%.4- To Existing or Abandoned System on Loth On Adjoining Lots To Water Main/Service Line A) i. To Cutbank(if7present) lr� To Stream/Pond/Lake/or Major Drainage Course,/�,.� To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed ����fi Dimansions AJ 44 Size in GallonsManhole/Access (YM) r "Pump On" Level at, �,y� y "Pump Off" Level at 4W/ High Water Alarm Level atVent (YM) Tested for a /ey Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) /tea Comments ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or, conformd to all MOA HAA Guidelines in effect on the date of this inspection. V%% Signed OF Si ed - Date f2 /rJ O AV, °°....°.. � /•'. C° a. Compan )A l= C / rU� MOA No. 5,T 94- o z14 * : RS°� *0 9 • �• •U• a°an.-0 ° i9 KB1/d5/s •�••• 14804 a /Qn.f.-n�a °coon •a l C. Reid, Jr. �'���°• ° Na. 2251 c (Page 2 of 21 2-15-84 i I